Therapeutic Lymphaticovenular Anastomosis for Breast Cancer-Related Lymphedema: A Critical Narrative Review of Comparative Evidence

This critical narrative review examines clinical outcomes of therapeutic lymphaticovenular anastomosis (LVA) for established breast cancer-related lymphedema and proposes a coordinated outcome assessment. MEDLINE/PubMed, Embase, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched through 6 September 2026. Comparative studies were selected purposively, with clinical series, imaging and physiological studies, and evidence syntheses providing context. We examined outcomes, comparators, follow-up, and study limitations without quantitative pooling. A six-month interim randomized analysis found no convincing between-group differences in the total Lymphedema Functioning, Disability and Health (Lymph-ICF) score or volume measures. The physical domain and reported compression use favored LVA plus conservative treatment. These findings require consideration of outcome hierarchy and multiple comparisons. Selected observational studies reported improvements but were vulnerable to confounding. The proposed framework coordinates a minimum clinical dataset, including prescribed and actual compression use, with optional measurements of anastomosis status, transport, and tissue characteristics. It aligns technical and clinical assessments over time to explore their relationship. The selected clinical findings suggest possible benefits in symptoms and treatment burden but do not establish sustained independence from compression. The framework is a research proposal and does not provide validated rules for patient selection.